Injection Practices as Seen by Drug Users in Senegal. An Analysis of a ‘Magnifying Glass’ Effect of Global Health

Sharing used injection equipment is one of the main ways in which drug users run the risk of infection (e.g., with HIV, or hepatitis B and C). This has led to the introduction of harm reduction (HR) strategies, such as needle exchange programmes (NEPs). Injection use is considered to be less widespread in West Africa. This article analyses the perceptions of drug users regarding injection, the place they assign it among consumption methods, and their views on the NEP implemented in Senegal. The data come from an immersion-based study and from interviews with 22 drug users, as well as from observations conducted between 2019 and 2021 in Dakar and Mbour. Injection is perceived by drug users as the most dangerous method of intake, exposing them to risk of death through infection and overdose; and people injecting drugs are seen as being at the ‘last stage’ of addiction. The reasons for injecting are related to the characteristics of the drug, to the perception of withdrawal symptoms, or to lack of money. For some, the NEP is useful because, although injectors seem fewer in number, the practice persists, and injectors hide to avoid discrimination from their peers. For others, the NEP represents a contradiction, as it encourages the consumption of injectable drugs. Users denounce the term ‘injectable drug users’ as a deliberate attempt to highlight and normalise the practice of injection. Thus, there appears to be a disconnect between global health strategies, which focus on injection and create a ‘magnifying glass effect’ on this minority practice, and local perceptions, which consider it to be on the decline.